Intended for healthcare professionals

Letters

Prehospital care for road traffic casualties

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7358.279 (Published 03 August 2002) Cite this as: BMJ 2002;325:279

Untrained doctors' first aid kit is simple

  1. Mark J Coates, associate specialist (mark{at}coates999.supanet.com)
  1. Accident and Emergency, Rochdale Infirmary, Rochdale OL12 0NB
  2. Medical Microbiology, Exeter Public Health Laboratory, Exeter EX2 5AD
  3. University of New Mexico, ACC 4-West, Albuquerque, New Mexico 87131, USA
  4. Saint Joseph Mercy Hospital, 4888 South Ridgeside Circle, Ann Arbor, Michigan 48105, USA

    EDITOR—Coats and Davies make the point in their article that the prehospital arena is not an area where untrained and inexperienced doctors can be expected to perform at a high level.1 The point is also made, however, that all doctors may expect to pass or come across motor vehicle accidents during their lifetime and should be able to provide at least good quality first aid until other emergency services arrive at the scene. What equipmentis required to enable the inexperienced doctor to provide this first aid?

    Most preventable trauma deaths occurring before the emergency services arrive are caused by an obstructed airway. Many doctors carry pieces of equipment and kit just in case something happens—intravenous cannulae or drips, for example—but in reality, surprisingly little equipment is required.

    • A high visibility jacket is essential.

    • A supply of latex gloves will enable airways to be cleared and opened and pressure to be applied to bleeding points

    • A pocket mask will enable ventilatory support to be given to apnoeic patients (whether due to trauma or medical causes)

    Medical practitioners can rely on all other supplies coming in the ambulance response. This equipment will enable a doctor to save most salvageable trauma patients likely to die in the time between an accident occurring and an ambulance arriving, and I would recommend it as being cheap, easily acquired, and with a long life.

    MC is a member of Med-ALERT (All Lancashire Emergency Response Team).

    References

    Doctors should offer themselves as a resource

    1. B Salkin, locum appointment for training specialist registrar
    1. Accident and Emergency, Rochdale Infirmary, Rochdale OL12 0NB
    2. Medical Microbiology, Exeter Public Health Laboratory, Exeter EX2 5AD
    3. University of New Mexico, ACC 4-West, Albuquerque, New Mexico 87131, USA
    4. Saint Joseph Mercy Hospital, 4888 South Ridgeside Circle, Ann Arbor, Michigan 48105, USA

      EDITOR—I applaud Coats and Davies for their article advising how doctors should assist at road traffic crashes.1 They say that safety is key, so emergency services should be called if this has not been done, and they further highlight the need to state precise location details to the emergency services.

      I would like to supplement their advice with the following suggestions.

      Consider obtaining a high visibility jacket and a doctor's green flashing beacon as additions to your car's medical kit.

      When assessing safety at an incident: firstly, if an emergency service vehicle is “protecting” the scene of the accident, one should drive past the scene and walk back (keeping out of the way of traffic). Secondly, the person who is first on the scene should assess whether it would be safer to use one's own vehicle to “protect the scene,” especially if the vehicle can be placed where very visible with a warning device such as a doctor's green flashing beacon. One needs to weigh up the risk of one's own vehicle being struck against the protection afforded to rescuers and the incident scene.

      Using the emergency telephone on the hard shoulder of the motorway gives a fixed location unlike a mobile phone.

      When a mobile telephone is used, precise location details become essential, as although the number is passed to the emergency services, location cannot be derived from the mobile's number alone. Although the memorable 999 has been in use in the United Kingdom for longer than 112, there is a theoretical advantage to using 112 from a mobile. If the cellular base transmission station is full, a 999 call will fail as the station has no space for it. The global standard specification for mobile phones calls for the station to replace an existing non-112 call with the 112 call instead, so a 112 call may succeed where a 999 call fails.

      Since paramedics can be wary of doctors offering assistance in the street, one should, first, offer identification—confirming one's qualifications; second, give them an indication of one's level of expertise; and, third, make it plain one respects their skills and specialisation in prehospital care. In practice, I try to present myself as a resource they can use, for example using a bougie at a difficult intubation, where their protocols do not allow them such, or using ketorolac (unavailable to paramedics) for analgesia.

      BS is a member of a voluntary aid society, undertaking occasional duties with them on an unpaid basis, and has in the past assisted on a voluntary basis at incidents he has come across while driving.

      References

      Spinal immobilisation should be done selectively

      1. Darren Braude, assistant professor of emergency medicine,
      2. Robert M Domeier, emergency medical services coordinator
      1. Accident and Emergency, Rochdale Infirmary, Rochdale OL12 0NB
      2. Medical Microbiology, Exeter Public Health Laboratory, Exeter EX2 5AD
      3. University of New Mexico, ACC 4-West, Albuquerque, New Mexico 87131, USA
      4. Saint Joseph Mercy Hospital, 4888 South Ridgeside Circle, Ann Arbor, Michigan 48105, USA

        EDITOR—Coats and Davies imply that all victims of motor vehicle collisions require spinal immobilisation.1 This is not true. Although immobilisation has been the standard procedure in the United States, Great Britain, and many other countries, it is not the standard worldwide. Examples of areas where spine immobilisation is not the standard are Malaysia and large portions of Australia

        Spinal immobilisation is not a benign procedure. It is uncomfortable and adds time and expense to prehospital and emergency department care. Many patients are transported to the hospital only because they are immobilised. Many of these patients receive radiographs only because they arrive immobilised or develop back pain as a result of the immobilisation. We agree with Coats and Davies that we still do not know if this is a beneficial procedure even in patients with known or high suspicion of spinal injury.

        A growing body of literature indicates that trauma patients may be individually selected for immobilisation by providers of prehospital care on the basis of simple criteria.24 These criteria include neck pain or tenderness, reliability of the clinical examination, and neurological deficit. The National Association of Emergency Medical Services Physicians has endorsed these criteria through a position paper, and they are steadily gaining acceptance in emergency medical systems in the United States.5 It is time that we scrutinise the widespread practice of immobilising all trauma patients and adopt the more reasonable approach of selective immobilisation.

        References

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